- Highmark Health (Columbus, OH)
- …Highmark Health **Job Description :** **JOB SUMMARY** The Senior Marketing Analytics Analyst plays a critical role in transforming customer, digital, and campaign ... analytics skills, and deep understanding of healthcare customer journeys-including Medicare , Medicaid, Commercial, and provider engagement pathways. Experience with… more
- Prime Therapeutics (Columbus, OH)
- …Pharmacy Benefit Management (PBM) or healthcare experience with understanding of Medicare , Medicaid, the Exchanges along with regulatory compliance requirements ... future of pharmacy with us. **Job Posting Title** IT Analyst **Job Description** The IT Business Systems Analyst... Analyst **Job Description** The IT Business Systems Analyst is responsible for solving moderately complex system problems… more
- Cognizant (Columbus, OH)
- **Job Title: Sr. QNXT Configuration Analyst ** **Location:** **Remote** **Job ID:** **00067091141** **About the role** As a **Sr. QNXT Configuration Analyst ** , ... by configuring and maintaining QNXT systems to ensure accurate claims processing and compliance with client requirements. You will be a valued member of our… more
- Humana (Columbus, OH)
- …and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence Engineer will be an integral ... comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root causes driving issues and developing solutions +… more
- Molina Healthcare (OH)
- JOB DESCRIPTION Job Summary Provides analyst support for claims research activities including reviewing and researching claims to ensure regulatory requirements are ... requiring reprocessing or readjudication in a timely manner to ensure compliance . * Works collaboratively with internal/external stakeholders to define claims… more
- Humana (Columbus, OH)
- …cross-functionally with market leadership, accounting, actuarial, clinical, operations, and Medicare counterpart teams. + Work closely with market actuaries; assist ... to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Highmark Health (Columbus, OH)
- …adjudication. + ICD9, CPT, HPCPS coding knowledge/experience. + Knowledge of Medicare and Medicaid policies **LICENSES or CERTIFICATIONS** **Required** + None ... **Preferred** + None **SKILLS** + Knowledge of principles and processes for providing customer service. This includes customer needs assessment, meeting quality standards for services + Knowledge of administrative and clerical procedures and systems such as… more
- Molina Healthcare (Cincinnati, OH)
- …with operations leadership and Plan Support functions to review compliance -based issues for benefit planning purposes. **KNOWLEDGE/SKILLS/ABILITIES** + Maintains ... + Knowledge and experience with federal regulatory policy resources including Centers for Medicare & Medicaid Services (CMS) and the Affordable Care Act (ACA). +… more
- Molina Healthcare (OH)
- …achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and state regulatory requirements are met for ... resolving complex business challenges that impact cost-containment and regulatory compliance . **Essential Job Duties** _Business Leadership & Operational Ownership_… more
- Humana (Columbus, OH)
- …Performing utilization management activities for assigned areas. Ensures full compliance with contract requirements, policies and procedures, and performance ... for ACD participants. + Review ABA TPs for policy compliance + Review pend queues for pended authorizations +...living in Puerto Rico. + BCBA (Board Certified Behavior Analyst ) Certification + 3 or more years of experience… more
Recent Jobs
-
Commercial & Specialized Industries Summer Analyst Program
- JPMorgan Chase (Atlanta, GA)
-
Senior Flight Engineering Manager
- Boeing (Hazelwood, MO)
-
Senior Protection & Control Engineer
- Qualus (Lake Mary, FL)
-
Staff Structural Engineer - Aviation & Federal (Atlanta)
- Burns & McDonnell (Atlanta, GA)